Surgery For Achilles Tendon May Not Improve Recovery

Readers have been asking about fixing Achilles tendon tears. They ask if tears can heal without surgery. Tears, even complete tears, can heal with the right rehab therapy even without surgery. A recent study of 92 patients made news when it concluded, "Surgical and nonsurgical treatment were equally effective for patients with acute rupture of the Achilles tendon."

Dr. Katarina Nilsson Helander, MD, of Kungsbacka Hospital in Sweden reported at the March 2010 American Academy of Orthopaedic Surgeons meeting, that outcomes and rates of re-rupture did not differ significantly through 12 months between patients getting surgery and those with physical rehab alone. Within 72 hours of injury, the 97 patients were randomized to surgery (48 patients) or no surgery (49 patients), followed by two weeks in a firm cast, then six weeks in an adjustable brace that allowed some movement of the foot. Both groups reported increased physical activity over time. All underwent identical rehabilitation programs. Complications in the surgical group included one contracture of the tendon, two wound infections (one deep and one superficial), and two nerve disturbances. Thirteen patients had concerns about the scar, 10 for cosmetic reasons and three for scar contracture and pain. Both groups were still below pre-injury levels at one year.



There is currently no consensus whether surgery plus physical rehab, or physical rehab alone is the favorable approach. That means, if you go to a doctor with your Achilles tear, you may be told that surgery is the only way, even though you may get the same results without the surgery. Many people hope to have surgery and be done with their problem, not knowing they will need the same physical therapy either way. Complications such as incision-healing difficulties, infection, contractures, re-rupture of the tendon, atrophy, complications and illness from anesthesia, bleeding, clots, scar pain, nerve pain, can arise from surgery. Drugs required during and after surgery can create new illnesses and further drug prescriptions. Surgical and healing outcomes vary with the skill, luck, and patient load of the operating team that day.

It is not new information that surgery may not always be required. Several studies conclude that non-surgical treatment yields similar results:
Soccer player David Beckham underwent surgery last week after tearing his left Achilles' tendon playing for AC Milan against Chievo. The news reported that the surgeon, Dr. Sakari Orava, said that, "The operation went smoothly and nicely" but that Beckham would not be able to play in this year's World Cup, saying "No,....healing (from the surgery) takes a long time."

You have choices if surgery is not right for you.


Fitness Fixers To Keep Your Achilles Healthy:

• Better Achilles Tendon Stretch
• Fast Fitness - Built In Functional Achilles Tendon Stretch
• Fast Fitness - Better Standing Hamstring, Achilles, and Inside Leg Stretch
• Functional Achilles Stretch
• Friday Fast Fitness - Partner Achilles Tendon Stretch
• Achilles Stretch in the Bathroom
• Plantar Fasciitis Part I
  

Supportive Shoes Increase Tightness and Problems

• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
• Why So Many Aerobics Injuries?
  

Fitness Fixers on Surgery:

• Knee Tracking Surgery - Tracking Outcomes
• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• Anterior Cruciate Ligament (ACL) Surgery Unnecessary
• What Works Better Than Knee Surgery?
• Another Reason to Avoid Surgery - Catching Fire "A Bigger Risk Than Thought"
• Prevent Back Surgery
• Fix Disc Pain Without Surgery
• Studies Say Back Surgery Not Needed

Labels: achilles stretch, drugs, injury, surgery

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Reader Success - Using Good Bending For Shoveling Snow

About two feet of snow fell over the weekend in the Northeast US. I got a lovely Christmas card shortly after. I wrote back to thank the sender for remembering me.

KathyB replied,

"I not only remembered you, I've had you on my mind, as I so often do. I was thinking on Sunday, after I'd shoveled snow for 3 hours straight without hurting my back, and again yesterday when I did another half hour, that you gave me a gift that just keeps on giving, that I'll NEVER forget what you've done for me, and I thought how wonderful it must be to be able to do something like that for people.

"I wish you and Paul the very best always,

"Kathy"

Kathy - you make it all worthwhile.
Kathy writes well. In fact, she is a professional mystery writer. I will ask her to tell us about some of her exciting books in the future.

In 2006 KathyB stopped 13 years of back pain using my work. She describes what she did in the comments of:

• What Abdominal Muscles Don't Do - The Missing Link.

She checked good bending habits for her back and inflamed Achilles tendon in the comments of:

• Disc Pain - Not a Mystery, Easy to Fix

She brought up important questions in the comments of:

• Exercise is More Important Than Calcium Supplements for Bones

Random Fun Fitness Fixer:

• Thaipusam - Exercise of Body and Spirit

Labels: abdominal muscles, achilles stretch, cold, fix pain, lower back, readers inspiring story, shoveling/digging

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Fast Fitness - Built In Functional Achilles Tendon Stretch

Here is Friday Fast Fitness - get a free, built-in stretch for the Achilles tendon in the way your legs need to stretch during normal movement.

1. Every time you bend with the squat, keep both heels down on the floor (upper right drawing) instead of raising heels (left).


2. Every time you bend with a lunge, keep the front heel down, not lifted up and shifting forward to the toe.


3. When ascending stairs, step up on your entire foot including the heel, down on the step, not just the toes and ball of the foot.

Many people stretch their Achilles tendon holding still. Is it such a mystery to get a pull during movement? Prepare your body how to stretch during movement. This normal daily life activity practices lengthening under body weight during normal movement.

Why do a few seconds of Achilles stretch then go back to tight, shortened real life use. Get hundreds of free stretches built in to your day in a way that gives free muscle and bone building exercise too.

• Good bending benefits your back, knees, and Achilles Tendon at the same time.


• If you don't know good bending, start with Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending for the half-squat (crouch,


• and Strengthen Legs Without Knee Pain - Standing Lunge for the lunge.

Labels: achilles stretch, fast fitness, leg strength, leg stretch, squat

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Fast Fitness - Count How Many Times You Help Or Hurt Your Body Daily

Here is Fast Friday Fitness - a simple tool to help you notice how many times during your ordinary day you can either get functional built-in exercise for leg, back, and hip muscles plus a Achilles tendon stretch, or produce a common factor in back and knee pain.

1. Every time you bend down to reach or retrieve something, count it
2. See how many bends you do for ordinary chores and by the end of the day
   
3. Choose if you want to hurt or help your fitness each time.

David from Belgium has written numerous Fitness Fixer success stories and created many photos and videos for better learning. He writes:

"I just spent half an hour vacuuming our house downstairs.

"When I do chores like these, I try to practice some focus instead of letting my mind wander all over the place.Usually this means I try to remain aware of my breathing (breathing normally, not grunting, straining, or holding breath to reach or lift things).

"But today I thought of one of your articles that said how many times on average a person bends over during the day. So I decided to count this for myself, just for fun and something to focus on.

"In the roughly 30 minutes of vacuuming, I counted 67 squats. Now that's a good workout! =)

Photos by David of squat and lunge for household bending

Bending over "wrong" is a common factor in back pain, and not only for out of shape people. It is common in many weight lifters. Bending "wrong is often done as an exercise. It doesn't strength back muscles as much as other ways, and puts large load on the discs, So it's not a helpful trade-off.

Previous Fitness Fixer posts explained that doing a few good rehab exercises and stretches for back pain won't undo a day of bad bending, and that you bend hundreds of times each day. "Fitness as a lifestyle" does not mean doing crunches during TV commercials or doing squats while on the phone. It means how you live. Get real exercise, built in, during real daily movement.

You get to choose whether you add an obvious check mark in the pile of things that don't benefit your fitness or whether you get functional exercise.


Fitness Fixer post on good bending for knees and back at the same time:

• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending

Related Fitness Fixer:

• How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• Readers Count - Second Missed Cause of Back Pain With Golf
• Household Fitness in the New Year
• Fast Fitness - Better Back and Leg Exercise When Vacuuming
  
  

Labels: achilles stretch, fast fitness, knee, lower back, readers inspiring story, squat, tests of fitness/health

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Fast Fitness - Better Standing Hamstring, Achilles, and Inside Leg Stretch

Here is Fast Friday Fitness - get a better stretch for the hamstring of the standing leg when stretching the other leg to the side:

1. When you stand with one leg stretching to the side, notice the leg you are standing on. It is common to stand with the foot turned outward and the hip rounded under you.
2. Instead, turn the standing leg to face directly ahead. Knee and toes straight forward. Not turned out, not even a small amount. Stand straight.
   
3. Notice the stretch move to the back of your leg.
   

Stand straight without leaning over, rounding your upper body, or letting your hip round under you. This is different from the way most people are used to.

The straighter you stand, the more stretch, while training the function of healthy posture - a functional stretch. You need to be able to lift one leg without being so tight that your back rounds and your hip rolls under. Think of stairs, kicks for dancing, aerobics, martial arts, stepping over things, stairs, much real life. If you are not only using bad mechanics for daily life, but training unhealthful tight mechanics with conventional bent over stretching, what are you accomplishing?

If you can't stand straight, lower your leg to where you can. There is little point stretching for health while practicing unhealthful ways.

Last year Leslie was featured knocking off 30 push-ups in Are You Stronger Than A 67 Year Old Lady?

What has happened in a year? She can now do 40 push-ups. We just don't have a video camera. While we get one, click the link to do your push-ups with her each morning while it is still only 30.

Related:
Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
Quick Hamstring Stretch At Work
Doorway Hamstring Stretch
Healthier Hamstring Stretching

Labels: achilles stretch, aging, fast fitness, hamstring, hip stretch, leg stretch, martial arts, readers inspiring story, stretch, upper back, yoga

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Cardiovascular CleanUp

Labels: achilles stretch, aerobic, circulation, hip strength, leg strength, leg stretch, performance enhancing modality, readers inspiring story, squat, strength, stretch, warmup

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Friday Fast Fitness - Partner Achilles Tendon Stretch

Here is fast Friday Fitness - relax, have fun practicing stretching and cooperating with a friend, and have a nice - Achilles stretch:

1. Stand facing a partner at arm's length. Hold each other's hands or arms. Keep arms straight.
2. Each partner leans and pulls back with straight arms while bending knees keeping heels down on the floor.
3. Bend only as far as is fun and feels good. Keep leaning back. Keep heels down.

The point is not to squat to the floor, the point is to stretch the Achilles and learn healthy movement habits that you can use for real life. Keeping heels down when bending knees accomplishes the point. If someone is tight, they don't have to bend as far to get a big stretch. Raising heels loses the stretch and the point. Don't squat all the way with heels up, keep heels down.

Whenever you stretch, remember the point of a stretch instead of straining to an arbitrary endpoint.

• Learn good bending habits: Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.
• When should you use good bending habits?: How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending.
• Daily examples: Household Fitness in the New Year.
• Fun book for Stretching Smarter Stretching Healthier.
  

Labels: achilles stretch, fast fitness, partner exercise, stretch

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Down the Stairs

Readers Carol, Don, Teresa, AJ, and others asked about strength, and knee pain and placement when descending stairs.

Physical trainer Teresa wrote:

"Hello Dr. Bookspan,
"The post on "Better Exercise on the Stairs" from July 2007 contains the following statement: 'When descending stairs or hills, bend your knees when landing for soft shock absorption. Don't step down on a straight, locked, knee.'

"Some clients I work with have the habit of descending stairs on one leg because they can land straight-legged on the "weak" leg. Pain or fear of pain keep them from having the confidence to bend that "weak" leg sufficiently to support themselves for a soft landing on the other leg, but the "strong" leg will let them land softly on the "weak" one. When I get them to practice it, they find the proper motor pattern that is pain-free, but end up falling back on the old motor pattern that creates pain.

"Do you have any ideas on this one since descending usually requires more use of the toes than climbing the stairs does?

"I keep recommending your site to loads of people because you are sooo right. It's about motor patterns of moving our bodies, not just "exercise." Thank you for your time and assistance!"
Teresa Merrick, M.A.
ACSM HFI, NSCA-CPT/CSCS, NASM CPT
Master Trainer

Climbing stairs is a functional (real life) skill. Not having the strength to support your own body weight is serious weakness:

1. It is not healthy to land straight-legged with a locked knee on either a weak or strong leg. The functional life skill needed to descend the stairs is similar to what is needed for simple daily healthy bending (right drawing). Bending knees to retrieve and reach is something everyone needs to do many times a day. How many times a day do you think you bend for ordinary actions? Click How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending


2. Use the simple built-in life activity of healthy bending using the half squat (right drawing) to train your legs for the strength and mobility needed to descend stairs in a healthful way.


3. When you bend in the half squat, keep both heels down and your weight shifted back over the whole foot (right drawing), not just the toes (left-hand drawing). Pull back more to the heels if you slide forward.
   


4. No need to increase the inward curve, called hyperlordosis, or overarch (left). Hyperlordosis pinches the spine and can cause impingement and mystery back pain (Prevent Back Surgery). Overarching is sometimes taught to weightlifters because it shifts some of the effort onto the lower spine joints called facets, making the lift easier. It is healthier to keep the weight on the muscles and not overarch. Keep neutral spine (right drawing).
   


5. Keep heels down for bending using the half-squat, instead of lifting the heel. Keeping heels down shifts weight to the thigh and hip muscles and off the knee joint. Enjoy the free, built-in Achilles stretch with each bend. Specifics on this in the post Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.
   


6. Descending the stairs should not be a toe-intensive maneuver. Your body weight belongs on the strong muscles of the thigh and hip.

Once you have the idea of the healthy bending you need for daily life bending, transfer that healthy movement to the stairs:

• Keep more weight on the leg on the upper stair, instead of flopping and stomping all weight down on the foot that is stepping down.
• Keep your weight back more toward the heel on the upper leg.
• Keep heel down longer on the upper leg, instead of lifting the heel right away. Get the free, built-in, functional Achilles stretch.
• Bend knee slightly upon stepping down instead of landing straight-kneed. Remember this is the same strength and skill that you need and have been developing (or should have) for ordinary daily bending, which totals many dozens every day.
• Use good shock absorption from the thigh muscles of the leg stepping down.

Instead of dong artificial leg exercises like leg raises, use legs for real life to get automatic built in exercise in the way you need to move. The movement gives built-in strengthening and stretch and movement patterns. The built-in strengthening and stretch and movement patterns directly improve daily function.

More will come in future posts. Have a real life of activity and fun, and enjoy.

Related:

Better Exercise on the Stairs
Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs
Click the label "stairs" under this post for all Fitness Fixer articles on stairs.

Labels: achilles stretch, fix pain, impact, knee, leg strength, leg stretch, lower back, squat, stairs

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Plantar Fasciitis Part I

Raina and several other readers asked about plantar fasciitis.

On a house, a fascia is a flat horizontal surface just under the roof. In your body, a fascia is flat fibrous tissue that wraps your muscles and soft structures. You have fascia in several places. One is across the bottom of your feet. "Plantar” means the bottom of your foot that you "plant" on the ground. Your plantar fascia is the fascia on the bottom of your foot. Plantar fasciitis is an inflammation (-itis) of the fascia on the bottom of your foot.

Normal Plantar Fascia Action
When you walk or run with your feet facing straight ahead, the line of bending of the foot is straight from front to back. Each step gives you a nice, built-in small stretch across the bottom of your foot. As you walk, run, jump, and move, your plantar fascia transmits body weight across your foot. It is part of shock absorption for your entire leg.

How Bad Movement Mechanics Hurts
Several things can make the fascia tighten and hurt. Here are three. More to come in future posts:

1. When you walk or run with feet facing outward, the fascia loses the normal stretch. Over years of not getting its normal stretch, it becomes tight. Walking with feet facing outward also puts sideways forces on the fascia with each step instead of the needed stretch. Walking with poor shock absorption, banging down heavily with each step can amplify strain forces on a tight fascia. Every step you take on a tight fascia yanks on the heel where it attaches. Eventually the heel and bottom of the foot get irritated from the yanking and start to hurt. Irritation can eventually cause the bone to thicken to protect itself - a heel spur.

The tighter your Achilles and foot fascia, the more "normal" it feels to walk toe-out. In a circular problem, walking toe-outward is a common fascial tightener. It may be "natural" with tightness, but can increase tightness over time.

2. Letting ankles constantly sag into pronation (flattened arches) is another fascial strain. Keeping body weight more evenly around the sole of your foot, not pressing and downward on your arches, lifts the weight off the arch. Reader David from Belgium made us a great short video of easily changing from rolling in on the arches to holding straight in Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches.

3. Hard sole shoes and some fasciitis braces stop the sole from getting the normal lengthening while walking, stopping the pain from the stretch, giving the false impression that the injury is lessening. A negative cycle continues of shortening and continuing the source of the injury. Injections briefly make the area more prone to injury. Pain pills allow you to continue the injury process without pain telling you that it is wrong. Several kinds of anti-inflammatory and pain medicines interfere with healing. Wearing high heeled shoes raises the heel, shortening the length of the Achilles tendon, putting less stretch on the tendon, the lower leg muscles, and the fascia of the foot.

Fasciitis can be quickly stopped. It does not have to be chronic. "Doing" a few stretches does not undo a lifestyle of shortening, tightening, and straining. Forcing tight, artificially straight position instead of creating the length and use of the area that allows healthful motion, can create more pain in other segments. Use your brain and learn good body movement to allow it to heal and be functional.

Helpful links to move in healthy ways to stop plantar fasciitis:

• Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches
• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Arch Support Is Not From Shoes
• Better Achilles Tendon Stretch
• The book Fix Your Own Pain Without Drugs or Surgery has a section on fasciitis, the many unhealthful lifestyle contributors, and simple lifestyle fixes to build into daily life and your exercise classes.

Labels: achilles stretch, feet, fix pain, injury, plantar fasciitis, pronation, running, walking

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Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life

Reader Jill hasn't sent a photo yet, but her words are a beautiful picture. Her story can help many readers stop pain and improve strength and function for happier daily life.

In the post Lunges and Beans Jill commented on Celiac disorder, an immune reaction to foods with the gluten protein - principally wheat plus a few others. Symptoms can be baffling until identified as coming from gluten.

Jill writes: "I had bad and steadily worsening joint problems, especially in the knees, for ten years before I found out about my gluten sensitivity. By that time my legs were extremely weak from having been unable to put weight on a bent knee for so long.

"I let the knees heal without doing anything special for them until I hit a plateau, then started doing isometric exercise for the quads (the classic wall chair), then six months after that started running slowly on an elliptical trainer. Weightlifting exercises for quads, though, still left me hobbling.

"That's where I was when I found your blog, and since then I've been doing squats at every opportunity, which was very hard at first and got much easier. Along with the foot stretch you gave, the Achilles tendon stretch in the squats also caused tremendous improvement in my plantar fasciitis.

"After a few weeks of that you posted the stair climbing posts and now I'm having far less trouble on the large numbers of stairs I climb every day. I am shying away from lunges from long associating them with pain, but plan to get over that soon and try them (gently) according to your detailed suggestions.

"Your blog has given me an enormous number of ideas to help in rehabilitating my knees from the years of gluten, which has made an enormous improvement in my quality of life. Thank you for the care and skill you put into it."

Jill, thank you for your care and skill to write things that will help many, and to do empowered good work to shine again. I put the posts with their links. Everyone, add your favorites:

• Foot stretch - Healthy Toe Stretches
• Achilles stretch - Better Achilles Tendon Stretch
• Achilles stretch built into daily bending with half-squats - Bending Right is Fitness as a Lifestyle and Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Happy knees during stair climbing - Better Exercise on the Stairs
• Plantar fasciitis - see the comments in Why So Many Aerobics Injuries?
  
• Lunges - Strengthen Legs Without Knee Pain - Standing Lunge and Strengthen and Retrain Function With The Lunge
• All posts helping knees

To stop pain and regain your life, you don't have to "do exercises" - use movement for healthy life. Have fun. Shine!

Labels: achilles stretch, celiac, feet, fix pain, knee, lunge, planter fasciitis, readers inspiring story, squat

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Strengthen Legs Without Knee Pain - Standing Lunge

Many people know they need to bend "right" but don't because it hurts their knees.

Bending right will not hurt knees. It will help fix one of the things that has been injuring them - bad bending habits which pressure and grind the joint.

Good bending will also give your knees the exercise they (and you) need.

Some knee patients are told to never "bend right" with a half-squat or lunge because it is bad for the knee. There are specific things about bending and straightening the knee that can increase certain kinds of pain, to be covered in future posts. Use your brain and try the following gently and safely. Done right, it should reduce knee pressure, not increase it.


How To Lunge:

1. Stand with one foot far in front of the other. Both feet face forward. (Left photo.)
2. Feet remain normal width from side-to-side, not directly in line front-to-back.
   
3. Lift your back heel. Don't turn the back toes outward. Look at your back foot and check.
4. Tuck your hip under (click "neutral spine" label for posts explaining how). You will feel a far better stretch and strengthener.
5. Bend both knees to lower straight downward. Don't touch back knee to the floor. Use leg muscles. Watch your front knee and keep it over your front heel, not sliding forward. (Right photo.)
6. Don't let your front knee sway inward.
   
7. Keep upper body upright and straight. (Right photo.)
8. Lower and rise several times, then switch legs. Keep feet still, not stepping forward and back.
   

Tips:

• To keep healthy knee positioning for the front knee, peek downward to see your front knee and foot.
• You should be able to see your front toes all the way through the bend.
• If your knee slides forward covering your toes, you are shifting weight to your knee joint and off your leg muscles. This is one of two common ways to increase knee pain while bending. Letting the front knee sway inward is another.
  
• Keep front knee steady over your front ankle, not sliding forward or inward. You will strengthen and stabilize your knees and legs instead of hurt them. You will feel more muscle use when you keep healthful positioning.

Lunge is a Lifestyle, not an Exercise to "do" 10 Times:

No need to go to a gym to do lunges. Use the lunge for daily bending around the house. It will add up to many lunges every day, built-in as fitness as a lifestyle. The posts How Often Should You Be Healthy? and Bending Right is Fitness as a Lifestyle give ideas of how to use healthy bending for normal daily life.

Benefits of the Standing Lunge:

• Strengthen leg muscles
• Strengthen the knee
• Stop harmful forces on the knees from bad bending
• Stretch the front of the hip of the rear leg
• Stretch the Achilles tendon and foot of the back leg
• Learn knee stabilization
• Practice balance
  
• Retrain healthful bending for daily life - transferring to function instead of just being an arbitrary exercise - free exercise all day
• Retrain straight upper body position for bending - more functional exercise
• Provide beneficial general exercise, warming which makes further movement easier, and healthful body movement.

Have fun practicing this now. You will need the standing lunge for tomorrow's Fast Fitness - Quick Warm Up. Enjoy.

Labels: achilles stretch, feet, hip stretch, knee, leg strength, leg stretch, lunge, neutral spine, squat, strength

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Better Exercise on the Stairs

Old woman: Come upstairs and we'll make love.

Old man: I can NOT do both.

If you would like to strengthen legs and reduce knee pain while going up stairs:

• Don't lean forward (photo 1 above)
• Stand upright (photo 2 below)
• Keep your heel down on the foot that steps up.
• Push off the whole foot, feeling the push-off through the heel. Do not push off the ball of the foot.
• When you raise one leg to step up, don't let the other leg pull and bend forward. Keep the standing leg straight (not locked straight).

Many patients who come to me, previously unable to step up a curb without pain, can climb flights without knee pain using this repositioning. Stairs become not only accessible, but a source of the exercise their legs need to strengthen and regain function.

Keep your weight back toward your heel to use leg muscles instead of putting your weight on the front of your knee. You will get knee pain relief and a built-in Achilles tendon stretch with each step. Done right, you will feel a more muscular and strong push off, making stairs easier to climb and better leg exercise. Even if you have big feet and your heel is off the step, keep your heel down instead of going up "tip-toe."

Notice if you bend forward. Instead, stand straight. The post Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs explains how hip tightness increases bent forward posture when raising one leg for kicks and activities like stairs, and shows how to hold straight body position instead, to stop tightness, and get a built-in hip and body stretch.

When descending stairs or hills, bend your knees when landing for soft shock absorption. Don't step down on a straight, locked, knee. Future posts will cover more about stairs. Have fun improving leg strength and knee function by taking the stairs during daily life in a healthy way. Send photos of your successes.

Next - Down the Stairs.

Labels: achilles stretch, fix pain, hip strength, knee, leg strength, stairs

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Strengthen and Retrain Function With The Lunge

The previous Fitness Fixer article Leg Exercise That Helps Your Back introduced the lunge. The lunge can be a quick effective fitness and health enhancer when you understand that you use it for real life bending, not just as an exercise to do for a set number of "reps."

The idea is to use the lunge in a healthy way instead of bending over "wrong" for all the hundreds of times you bend around the house and workplace. Then you stop one of the major sources of back (and knee) pain and degeneration while you get free built-in exercise, calorie burning, and leg and hip stretch and strengthening. The Fitness Fixer article How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending shows just how many times every day you need to know this.

Reader Ivy from New Zealand sent in the photo above right showing a great way to bend for some of the many times you need to bend to reach and get things - the standing lunge:

• Upright torso
• Bending straight downward, not forward
• Front shin pretty much vertical
• Front knee over the foot
• Front knee does not sway inward. This is key in retraining knee stability during real life bending, stairs, and other movement.
  
• Back foot facing ahead, not turned out
• Front heel down. Better for knee and gives built-in Achilles stretch
• Feet nicely spaced
• Hands free, not on front leg
• The side-seam of the jeans from hip to waist-band is vertical, not tilting forward. It is somewhat hidden by Ivy's arm, I know. But the idea is important - do not tilt your hip forward to stick the backside out in back. Keeping the side seam vertical does several important things to strengthen and stretch, and keep neutral spine that I will cover in future posts on lunging.
• Looks comfortable and doable.

When using the lunge, do not bog down in "rules" over placement. The idea is to move in simple, healthy positioning, not hold yourself rigidly.

Going to a gym three times a week is not fitness as a lifestyle. Instead of "doing" exercise, lift, and bend, and move in healthy ways all the time for real fitness as a lifestyle. Give it a try and send in your success stories.

• The Cause of Disc and Back Pain shows more on why healthy bending is key to fitness as a lifestyle
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending introduces the half-squat as one of several fit and healthy normal ways to bend for every day activities.
• How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• Household Fitness in the New Year shows examples using it in daily life
• Functional Fitness as a Lifestyle By Mail Room Workers is a top example of good thinking and moving at work
  

Labels: achilles stretch, hip, knee, leg strength, lunge, stretch

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Forensic Anthropology and Bone Density

A few weeks ago, I attended a lecture on forensic anthropology. In general, this is the study of things you can tell from human bones in a crime setting. How old was the person? Were they male or female? How big were they? What was their probable race or ancestry?

Why was I there when my work is with the living? Two main reasons. I am the science officer for the Vidocq Society, an international forensic society. I might evaluate data, for example in an aviation disaster, whether someone might have been conscious at each point when undergoing G-forces or different temperatures and amounts of oxygen after a depressurization at various altitudes. In a scuba death, I might advise on physical changes that occur with different situations. The second reason was to learn more about bones. Bones are remarkable. Your bones know a lot about you. What was your health like? Were you active? What kind of activity did you do? When I was small, I read about an archaeological dig in ancient Rome. The bones of a girl were recovered. The account stated they could tell she carried loads too heavy for her, and was therefore (in conjunction with other evidence) probably a servant or slave. I was riveted. How could they know that? I spent years after that learning more about telling how someone moved from looking at their bones.

Throughout your entire life, when you exercise you stimulate growth of new bone cells. The physical pull of muscles thickens your bones where the muscles attach. Using your arm muscles thickens arm bones. Using your legs strengthens leg bones, and so on. This is a main mechanism of how exercise prevents osteoporosis. Without exercise, you don't stimulate enough new cells to counter the normal loss as old ones break down. Your bones thin no matter how much calcium you eat. The post Exercise is More Important Than Calcium Supplements for Bones tells more about this. Bone demineralization is rapid and serious in astronauts in microgravity (Collapsing Astronaut Gives Healthy Reminder).

How you use your muscles causes them to pull differently, giving evidence about the kind of habitual motion. More interesting is that when you are active, your bones grow and shape themselves to facilitate your motion. An example of interest to readers following the posts on squatting is that people who habitually sit for normal daily life in full squat grow "squatting facets" on their lower leg bones. These are small areas on the bone that quickly grow to make squatting more comfortable. At one point, it was a debate in anthropology that squatting facets were a marker of someone of Asian ancestry, until it was found that others who squat also grow them, and that squatting facets disappear when the person adopts a Western sitting habit of chairs and no longer squats. Babies of all races can have them.

Someone who habitually slouches can change the shape of their bones, eventually deforming them. This can occur in the spine, knees, hips, ankles, shoulders, feet, toes - everywhere you pressure your bones. Changing positioning habits to healthier ones can, in many cases, reshape the bones back to healthier shape. Think of braces on your teeth. It's human bonsai. In cases of extreme dystrophies of the muscles, someone who sits without function of their trunk muscles to hold the spine upright, can eventually deform their spine until their ribs sit on their hip bones. How are you sitting right now? The recent post What Does Stretching Do? explained a bit of why stretching isn't reducing injuries. People are stretching, then exercising and going about daily life in bent over positions that rub and grind the joints and soft tissue.

You literally shape your own health. Use the articles throughout this Fitness Fixer blog to do healthy exercise in healthful positioning so that your bones will only tell good tales about you.

Related Fitness Fixer:

• Forensic Science
• Body Farm Not Just For Halloween
• Time of Death From Body Temperature?
• Fun Myths and Facts of Forensics in the book Health & Fitness in Plain English THIRD new edition - DrBookspan.com/books.

Labels: achilles stretch, aerospace, ankle, arm, feet, forensic, injury, leg stretch, osteoporosis, posture, scuba, sitting, squat, toes

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Functional Achilles Stretch

Sitting in full squat with heels down can be healthful and useful. Squatting for daily life is a built-in Achilles stretch, more effective and functional than the standard "lunge and lean stretch" against the wall, or lowering one heel from a step or ledge. Better Achilles Tendon Stretch shows one Achilles tendon stretch that is effective and quick. Sitting in a full squat is another. Rising from the squat adds functional leg muscle strengthening and balance.

I took the photo, above left, in an airport in Asia. The man was easily sitting to work on his laptop during the hour before boarding. Others were similarly sitting with laptops and mobile devices to get work done. Elders squatted that way to rest.

Achilles Stretch in the Bathroom introduced the full squat as a functional normal daily action used in many countries for resting, washing, gardening, working, washing, toileting, chatting on the phone, and other activities, and gave an idea of how to try it. Save Knees When Squatting explains how keeping the heels down rather than lifting heels to rest on the ball of the foot is safer for the knees. Reader Mim supplied a wonderful link in the comments for a great little film of the Asia squat. More Fun Squatting tells a funny squatting story.

People new to squatting may find their Achilles tendons are too tight to bend in this normal manner. Reader Ivy of New Zealand offered to demonstrate one easy way to practice this stretch in a safe way, and sent the photo at right.

Keep both heels down while holding something sturdy in front. Straighten your arms and lean back to shift weight away from the knee joints.

Squatting can be a nice stretch for your lower back too. I have been working, off and on, for some years on the interesting finding that slight forward spine rounding when just sitting on your heels in the squat (no weights) does not load the spine to the extent of sitting on your behind in a chair.

Be smart about trying it or not if you already have damaged knees. When rising, make sure to keep knees back over your feet, not sliding forward, which loads the knee joint, or inward at an angle (narrower than your feet), which can twist the joint. Either action can grind against the meniscus and cartilage.

Done properly, it should feel good on the Achilles and calf, lower back, be good exercise, not hurt the knees, and become an option for a functional stretch and even normal sitting ability.

Labels: achilles stretch, balance, leg strength, leg stretch, lower back, sitting, squat, strength, stretch

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Get Better Exercise From Your Chair

How many times do you get in and out of a chair everyday? It could be enough for a fair amount of exercise, if you use muscles instead of leaning forward (photo shows terrible sitting) and flopping down.

At a medical conference last year, a speaker droned endlessly about back surgery (even though Studies Say Back Surgery Not Needed, and you can Fix Disc Pain Without Surgery) and the usual tedious exercises that people must do three times a week (then they do unhealthy movement all day that causes the pain in the first place, or do their exercises in back damaging ways - Common Exercises Teach Bad Bending). An obese physician arriving late plodded to a chair next to me. She laboriously bent over, bending wrong to put her bag on the floor. She slowly bent over forward, bending wrong again to retrieve two cushions from the bag. She bent over wrong again to place one cushion on the chair seat, then again for the second cushion for the chair back. She turned her back to the chair, bent far forward, bent her knees a small amount, so slowly, then slammed her backside down to the chair with a WHUMP. She sat rounded for the rest of the lecture about surgery for disc herniation. Sitting and bending rounded forward is the major cause of disc "disease." To easily avoid disc pain and surgery see Disc Pain - Not a Mystery, Easy to Fix.

What to do instead? Any time you start to sit, check if you lean forward and stick your backside out. You shouldn't need to lean far forward to sit, or rise from sitting. If you have to lean, it is usually a sign of weak legs. If your heels come up as you bend your knees, your Achilles tendons are tight (or you have functional bad Achilles habits). You shouldn't (ordinarily) need to use your hands to sit or rise. Your balance and legs should do the work. Do you sit down heavily, not using leg and hip muscles to decelerate? Why jolt your spine and give up free calorie burning at the same time? Try this now to see:

Stand up, ready to sit -

1. Start to sit, keeping both heels down on the floor.
2. Don't lean forward. If you lean, correct it by tilting your hip under and raising your upper body to be straighter.
3. Keep both knees back over your heels. Don't let knees slide forward.
4. Keep knees parallel over your heels. Don't let knees sway inward.
5. Notice how you have to use far more leg and hip muscle, and the pressure of holding your body weight comes off the lower back and knee joints.
6. Notice if you reach for the arm rests, or other support, out of habit. Use your leg muscles instead.
7. Sit down lightly.

Start to rise from sitting -

1. Notice if you lean far forward or raise your heels or jut your chin forward.
   
2. Notice if you need to push off your hands.
3. Notice if your knees comes together. Don't let them.
   
4. Change how you rise to put both heels down on the floor, push off your whole foot including heels, and use your leg muscles to rise while holding your upper body more upright without jutting your neck and chin forward.

This is not a bunch of strange rules for sitting, or a weird, contrived exercise, it is just basic concepts for normal healthful daily movement.

The previous post explains why it is not healthy for your back or the best exercise to lean and stick out in back - Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats? It covered good knee placement too, so check that if you avoid healthy movement because of knee pain.

Exercise is still thought of as something you go and "do" instead of moving in real life. It's silly to do 10 squats in a gym or using your chair and then go back to unhealthy movement each time you sit or bend during the day. Have comfortable healthful movement all day. Sit and rise easily. That is exercise as a lifestyle.

Labels: achilles stretch, disc, leg press, leg strength, lower back, sitting, strength

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Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats?

A commonly repeated phrase in fitness training and programs is "neutral spine" and "tuck the tail" for healthier lower spine posture. Many people know this, repeat this, teach this, write articles about it, then jut their hip too far out in back and overly-arch their lower spine, doing just the opposite, when they squat, bend to pick things up, sit in a chair, and exercise (photo at left).

Tilting the hip too far outward in back overly-arches and hyperextends the lower spine - photo at left and left drawing below.

Hyperextrending the spine, creating too much lordosis (hyperlordosis) can result in unhealthful compression on the spine joints called facets, and on surrounding soft tissue.

Overarching shifts your body weight onto the spine joints and compresses them in a bent-backward position, eventually increasing back pain and joint damage.

Another issue is that if you cannot squat without sticking out in back or leaning your upper body far forward, it is a sign that your thighs are weak, your Achilles tendons are tight, you are not using your ab muscles, your balance is poor, or all four.

Why do so many programs teach to stick far out in back? It is well known that the opposite problem of tucking too much and rounding forward (lumbar flexion) contributes to back pain. People hear this and assume that the opposite, over-arching backward, will counteract that. They exaggerate the arch.

Overarching often initially seems to "work" because you can lift more since you shift some of the work from the muscles onto the lower spine (and sometimes knees).

The muscles do less, so it seems easier. Competition lifters use it to lift more, regardless of the pain and injuries it causes later on.

It is trend-breaking news to say don't stick your backside out too much to squat, and instead use neutral spine, shown in the right-hand drawing. I know. It goes against what fitness organizations and pop-science exercise books teach. I know. Try this to see for yourself:

• Stand upright with feet side-by-side, comfortably apart.
• Face both feet in the same direction as your knees.
• Bend both knees, keeping both heels down on the floor and over your feet, not sinking inward or bowing outward.
• Look down and see if your knees cover the sight of your toes.
• If you can't see your toes because your knees are forward blocking the view, pull your knees back (keeping them bent) until you are still squatting but can see your toes.
• Keep your upper body as upright as you can.
• Now, here is the point about the lower back - notice if you tilt too far out in back, pinching your lower spine backward like a straw. Overarching may be habit, or that you don't have the leg strength or balance, or your Achilles tendon is so tight that your heels come up from the floor. Instead, tuck the bottom of the hip under, just enough to bring the spine to "neutral." A small inward curve remains when you have neutral spine, but not a large one - Right-hand drawing.
  
• Raise your upper body to be more vertical, while staying in the squat.
• Notice how you have to use far more leg and hip muscle, and the pressure of holding your body weight comes off the lower back and knee joints.

Use healthy bending for all bending. Neutral spine helps squats for exercise, to pick up clothes from the floor, to get pet dishes, look in the refrigerator, get the laundry, pick up the kids, to sit down in a chair, and so on. You will get a far better workout for your thighs, keep weight off the joints of your knees and spine. It is healthier to squat upright than bending over forward to pick things up. It is not healthier to cause the opposite problem by overly-arching and pinching the spine back (increasing swayback).

Another point in spine health and exercise is not to "tighten" or clench your abdominal muscles to squat or lift. It is not healthy or useful to tighten muscles for movement. It is trend-breaking news to say "don't tighten." I know. It goes against what fitness organizations and pop-science exercise books have been teaching. I know. Tightening is not what supports your back. Moving your spine out of unhealthy over-arched position, explained in this post, to a more neutral position is what "supports" (you hold your spine in place) preventing pain and injury. Using the muscles to stop unhealthy position, and hold healthful position is how you support your back - not by tightening.

• The previous post explains tightening - Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine
• Also don't need to tighten gluteals - Gluteal Muscles Myth - Shaking The Dog's Paw
  
  

Fun effective exercises, without tightening or the forward bending of crunches or Pilates that causes so much back pain:

• Abdominal Muscle Exercise - Better, Different, Not What You Think
• If Better Abdominal Muscles Are Your New Year's Resolution, Try This
• Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique
• Change Common Exercises to Get Better Ab Exercise and Stop Back Pain

Have fun being part of this big and healthy change in fitness.

Labels: abdominal muscles, achilles stretch, lordosis, lower back, myths, neutral spine, squat, strength

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Save Knees When Squatting

American baseball catchers have the occupational risk of meniscus tears in their knees. Yoga practitioners of certain squatting moves like "the eagle" and the hindu squat are more likely to get the same meniscus cartilage tears and early joint wear and tear. Asians who routinely squat for so many activities of daily life don't get these injuries. The difference is keeping your heels down and your feet facing in the same direction as your knees.

Sitting in a full squat with your heels down and your weight back does not pressure the knees the way squatting with heels up does. Keep both heels down and keep your weight back on your heels.

People who are not accustomed to squatting often find that they are too tight in the Achilles tendon to sit all the way down. Many of these same people do Achilles tendon stretches every day, or at least they do a motion commonly taught as an Achilles stretch, but which barely stretches the Achilles. The "lunge and lean," is the least effective Achilles stretch. The post Better Achilles Tendon Stretch tells why and gives a better stretch to do instead. The squat is another good Achilles tendon stretch. It is a lifestyle stretch for the Achilles and lower back, and a hip, leg, and shin muscle strengthener. You get healthful natural exercise from regular daily life. Even if you can't get down to full sit, bend properly with both heels down for daily bending and you will get a free Achilles tendon stretch every time you bend, which is many many times a day. Holiday Leg and Abdominal Exercise tells more on this.

The trains here in Thailand have the luxury of a bathroom, including a squatting bowl. You can tell new tourists here. They are afraid of the bathroom. When we lived in Japan, even the gleaming modern Bullet train, the Shinkansen, had a spotlessly clean squat fixture. Train bathroomsgive you balance practice too, swaying with the train as it takes you to the next adventure.

Photo by Dr. Jolie Bookspan

Labels: achilles stretch, fix pain, knee, leg press, leg strength, leg stretch, squat, yoga

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